Arthritis Drugs May Help Critically Ill Covid-19 Patients, Study Finds

Patients were randomly assigned to receive infusions of two rheumatoid arthritis drugs, tocilizumab or sarilumab, or to receive standard care at the time, including corticosteroids for most patients.

The international team of researchers found that patients who received either medication for rheumatoid arthritis lived many more days without needing organ support than those who received standard care.

The data showed that patients receiving tocilizumab had a median of 10 days when they did not need organ support, and those receiving sarilumab had a median of 11 days. Patients who received neither of the two drugs had no days without organ support.

The researchers also found that 27% of patients who received either arthritis medication died in hospital, compared to 36% of those who received standard care.

“We have also seen patients recover faster,” he said. “They were improving and could be released from the ICU more quickly – and that was on average and each patient is slightly different.”

Some serious adverse events were reported during the study. Nine were among the patients treated with tocilizumab, including one bacterial infection, five hemorrhages, two cardiac events and one person had deteriorated vision. Eleven adverse events were among those who received standard care, including four hemorrhages and seven cases of blood clotting. No serious adverse events were reported in people who received sarilumab.

Even though the new study suggests that treatment with tocilizumab and sarilumab may improve outcomes in critically ill Covid-19 patients, the researchers noted that some separate studies had previously found no benefit with tocilizumab.

“Many previously reported reports included less critically ill patients and excluded patients already receiving respiratory support,” the researchers wrote in the study. “In these trials, there was no clear evidence to suggest that tocilizumab was effective in preventing disease progression, and no survival benefit was seen.”

“ The best way to use them remains uncertain ”

Among the 452 patients randomized to receive either a single intravenous infusion of tocilizumab or a placebo, the 28-day mortality rate was 19.7% in the tocilizumab group and 19.4% in the placebo group, according to the summary of the study.

“In this trial involving hospitalized patients with severe Covid-19 pneumonia, we found no significant difference in clinical status between the tocilizumab group and the placebo group on day 28. There was no benefit in mortality. been associated with the use of tocilizumab, although propelled for this result, ”wrote researchers from Baylor College of Medicine in Houston and several other institutions around the world.

Tocilizumab was well tolerated, the researchers said, and their data suggests that patients may have benefited from the drug, although more research is needed to be sure.

The differences between the studies include the severity of the patients’ illness, when the treatment was given, and what other types of treatment patients might have received, such as corticosteroids, Dr Eric Rubin, editor of New England Journal of Medicine, and its co-authors, Dr Dan Longo and Dr Lindsey Baden, wrote in the editorial.

“These points raise thorny questions,” write the authors of the editorial. “At this time, we have some evidence of the benefit of interleukin-6 inhibitors, at least under certain circumstances, but the best way to use them remains uncertain.”